Thursday, August 27, 2009

Under Obamacare, expect the Hippocratic Oath to end up being "no longer operative"

White House's health czar Dr. Frankenstein Emanuel will be sure to make it so.

"In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: 'Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.' (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained 'to provide socially sustainable, cost-effective care.' One sign of progress he sees: 'the progression in end-of-life care mentality from "do everything" to more palliative care shows that change in physician norms and practices is possible.'(JAMA, June 18, 2008).

'In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations,' he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

'You can't avoid these questions,' Dr. Emanuel said in an Aug. 16 Washington Post interview. 'We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a "God committee" to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.' "

He probably thinks he could re-structure something like that and make it work this time.